Leder M R, Emans S J, Hafler J P, Rappaport L A
Division of General Pediatrics, Children's Hospital, Boston, Massachusetts, USA.
Pediatrics. 1999 Aug;104(2 Pt 1):270-5. doi: 10.1542/peds.104.2.270.
To describe factors that prompt pediatric practitioners to suspect child sexual abuse, the barriers to inquiry, and the approach to management of cases of possible abuse.
Qualitative, descriptive, and case-based.
Six focus group interviews were conducted. Maternal and Child Health Bureau-sponsored collaborative office rounds groups nationwide participated in discussions of five vignettes. Each group interview lasted 1.5 hours and had 7 to 16 participants (n = 65). Audiotaped data were transcribed and analyzed independently for themes by two reviewers.
Five themes emerged from the group interviews: anticipatory guidance, red flags, approach to management, terminology used in discussions, and barriers to inquiry. All groups discussed giving anticipatory guidance about sexual abuse. Half (3/6) believed girls were more likely to be victimized, and some (2/6) gave more anticipatory guidance to girls for this reason. Although some groups reported giving anticipatory guidance about sexual abuse, many reported inconsistencies in their practice. All groups identified historical, behavioral, and physical red flags for sexual abuse but believed that they were not trained in residency to recognize these signs. There was no consensus regarding the approach to management of cases of possible sexual abuse, and many participants did not know the types of questions that they should be asking children when they suspect abuse. Members of all groups reported using imprecise terms when they discuss sexual issues with families. Most (4/6) believed that it was a practitioner's responsibility to inquire about abuse but believed that their discomfort with sexual topics was a barrier to inquiry. All believed that the most significant barrier to inquiry was inadequate training in the area of sexual abuse and that cases are missed because of lack of training.
Highly motivated pediatric practitioners reported that they give anticipatory guidance about sexual abuse inconsistently, that they were not trained to recognize red flags for sexual abuse, and that they do not have a consistent approach to cases of suspected abuse. Additionally, they reported that they are not comfortable discussing sexual issues and that they miss cases of sexual abuse primarily because of lack of training. Educational interventions that target these themes are essential to improve the ability of pediatricians to screen children and to intervene when sexual abuse is identified.
描述促使儿科医生怀疑儿童遭受性虐待的因素、询问过程中的障碍以及对可能的虐待病例的处理方法。
定性、描述性且基于案例。
进行了六次焦点小组访谈。由母婴健康局赞助的全国协作办公室查房小组参与了对五个案例的讨论。每次小组访谈持续1.5小时，有7至16名参与者（n = 65）。录音数据由两名审阅者转录并独立分析主题。
小组访谈中出现了五个主题：预期指导、警示信号、处理方法、讨论中使用的术语以及询问障碍。所有小组都讨论了关于性虐待的预期指导。一半（3/6）的小组认为女孩更有可能成为受害者，一些小组（2/6）因此对女孩给予了更多的预期指导。尽管一些小组报告提供了关于性虐待的预期指导，但许多小组报告其做法存在不一致之处。所有小组都确定了性虐待的病史、行为和身体方面的警示信号，但认为他们在住院医师培训期间未接受识别这些迹象的培训。对于可能的性虐待病例的处理方法没有达成共识，许多参与者不知道在怀疑虐待时应该向儿童询问哪些类型的问题。所有小组的成员在与家庭讨论性问题时都报告使用了不精确的术语。大多数（4/6）认为询问虐待情况是医生的责任，但认为他们对性话题的不适感是询问的障碍。所有人都认为询问的最主要障碍是在性虐待领域缺乏培训，并且由于缺乏培训而漏诊了病例。
积极性很高的儿科医生报告说，他们对性虐待的预期指导不一致，没有接受识别性虐待警示信号的培训，并且对疑似虐待病例没有一致的处理方法。此外，他们报告说在讨论性问题时感到不自在，并且主要由于缺乏培训而漏诊了性虐待病例。针对这些主题的教育干预对于提高儿科医生筛查儿童以及在识别性虐待时进行干预的能力至关重要。
